Efficacy of vaginal douching before the application of Dinoprostone pessary in labour induction, a randomized controlled study

Abstract

Aim: To investigate the effects on delivery and neonatal outcomes of vaginal douching, which can be performed before the application of dinoprostone pessary in the vagina for labour induction. Materials and method: In this prospective study 240 women with singleton, term pregnancy who underwent labour induction, were randomized into two groups. Application of dinoprostone pessary intra-vaginally with vaginal douching group (n=103) and it without vaginal douching group (n=116) were compared firstly for duration of dinoprostone application intra-vaginally secondly for duration from the beginning of dinoprostone application intra-vaginally to the active phase of labor, duration from the beginning of dinoprostone application intra-vaginally to total cervical dilatation, induction need, route of delivery (vaginal/cesarean), and uterine hyperstimulation. The birth weight, 1 and 5-minute Apgar scores, intubation need, NICU admission, presence of meconium, and fetal infection were compared between the newborns of the two groups. Data were statistically compared using the Student’s-t test, Mann-Whitney U test and Pearson Chi-square test. Results: Intra-vaginal dinoprostone pessary application with vaginal douching compared it without douching had shorter duration of dinoprostone application (p=0.001), duration from the beginning of dinoprostone application to the active phase of labor (p=0.001) and duration from the beginning of dinoprostone application to total cervical dilatation (p=0.001). Route of delivery was not statistically different between the groups (p=0.414). Uterine hyperstimulation was more frequent in the vaginal douche group however it did not reach the statistical significance (p=0.058). Neonatal mean birth weight and 5-minute Apgar scores were higher in the vaginal douching group (p=0.660, 0.091) while intubation need, presence of meconium, and fetal infection rates were lower with statistical significance (p=0.007, 0.018, 0.011, respectively). Conclusion: As a safe, easy to perform and cheap procedure, vaginal douching prior to dinoprostone pessary application intra-vaginally can augment the induction of labour in women without increasing maternal or fetal adverse outcomes.